MBBS OSCE · General Medicine
OSCE — Nephritic Syndrome & Acute Glomerulonephritis
Eight-minute OSCE station on Nephritic Syndrome & Acute Glomerulonephritis: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Nephritic Syndrome & Acute Glomerulonephritis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Nephritic syndrome is the glomerular inflammatory counterpart of nephrotic syndrome: haematuria (dysmorphic red cells and red-cell casts), subnephrotic proteinuria (typically under 3.5 g/day), hypertension, oedema and an acute rise in creatinine (AKI), caused by glomerular inflammation and cellular proliferation. Causes are split by serum complement: low C3/C4 (post-streptococcal GN, membranoproliferative GN, lupus nephritis, endocarditis-associated GN, cryoglobulinaemia, shunt nephritis) versus normal complement (IgA nephropathy — the commonest primary GN worldwide, IgA vasculitis/Henoch-Schonlein purpura, anti-GBM disease/Goodpasture, ANCA-associated vasculitis). The pivotal clinical dec
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Gross haematuria, rising creatinine and RBC casts — acute glomerulonephritis; ur |
| Safety | Rapidly progressive AKI (over 50% fall in GFR within under 3 months) with haemat |
| Safety | Haemoptysis with rapidly progressive GN — pulmonary-renal syndrome (anti-GBM Goo |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.